Proportion of NHS budget spent on primary care must double, says RCGP chair

The NHS must double the proportion of its annual budget spent on primary care to match the world's most effective integrated healthcare systems, the RCGP chair has said.

RCGP chair Professor Martin Marshall delivers COVID-19 vaccine (Photo: Leon Neal/Getty Images)
RCGP chair Professor Martin Marshall delivers COVID-19 vaccine (Photo: Leon Neal/Getty Images)

Speaking at the RCGP 'Fresh Approach' conference on 12 February, RCGP chair Professor Martin Marshall said the proportion of NHS funding spent on primary care has been in steady decline over the past two or three decades.

He warned that while the share of the NHS budget spent on primary care has dropped to around 9%, 'really good, effective integrated care systems spend around 20-25% of their total budget on primary care'.

During a Question Time-style debate at the online conference, the East London GP said: 'That’s the kind of figure we need to be looking for. That requires not only a transfer of money from hospitals - which are also underfunded - but also a rethink of where care happens and what the role of primary care is.'

Primary care funding

Speaking the day after the publication of a government white paper that set out plans for sweeping NHS reforms that will formalise the role of integrated care systems (ICSs) and see these organisations absorb and take over many functions from CCGs, Professor Marshall said it was this issue of the share of NHS funding for primary care that 'we really need these current reforms to address'.

The RCGP chair said that he found it 'incredibly frustrating' when he heard leading figures in politics or the media 'using hospitals as a synonym for the NHS'.

He told the conference: 'In the last decade or so we have got to a much stronger place. In particular I thank Sir Simon Stevens for that - who is the first NHS chief executive I’ve seen who has really understood the importance of general practice and who has really focused on general practice as the foundation stone of the NHS.

'But, and it’s a big "but", I think we have taken a step backward in the COVID-19 crisis. The media and politicians have been so focused on hospitals, so focused on TV news and ventilators, that we have kind of stopped talking about general practice - at least until the vaccination campaign came along.'

COVID-19 vaccination campaign

And the RCGP chair added: 'The real touchstone for whether we understand the importance of primary care is what proportion of the NHS budget is spent on primary care. Over the last two or three decades that has dropped and it continues to drop.'

NHS chief people officer Prerana Issar, also taking part in the debate, suggested that a shift in focus of healthcare spending would require a change in the general population's understanding of 'what health means'.

She said: 'If health means episodic medical intervention it's always going to be about hospital - if health means ongoing commitment to prevention and taking care of the underlying causes of ill health then it will shift to general practice. The NHS long-term plan has focused on prevention and health outcomes so I see this focus on hospitals from media and politicians linked to the the fact that as a population we see health as "I take a pill, I'm healthy" or "I have surgery and I'm better".

'Hopefully what we will see from COVID-19 is a renewed interest from politicians and the public on how can I be truly healthy, because that is the best insurance against some of the challenges - a focus on prevention.'

Read more from the RCGP conference

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